Form Approved
OMB No. 0920-0210
Exp. 09/30/2012
Recommended Ingredient Reporting Format - CSTHEA
Please attach additional pages if necessary
Public reporting burden of this collection of information is estimated to average 6.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0210)
Date
Office on Smoking and Health
Attn. FCLAA Program Manager
4770 Buford Hwy., NE, MS K-50
Atlanta, GA 30341
This ingredient report is being submitted pursuant to the Federal Cigarette Labeling and Advertising Act (FCLAA), 15 U. S.C. §1335 (a) Public Law 89–92.
Company Name(s)*
Brand(s)†
*If this Ingredient Report is submitted by a designated individual or entity on behalf of a cigarette manufacturer, packager, or importer, the form must specify on whose behalf the submission is being made.
Ingredient Name ¶ CAS Registry Number§
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| File Type | application/msword |
| Author | Ruth L Hayes |
| Last Modified By | Steinberg, Shari (CDC/OD/OADS) |
| File Modified | 2012-06-14 |
| File Created | 2012-06-14 |